Hemodynamics and early recovery characteristics of desflurane versus sevoflurane in bariatric surgery

Abstract

Context:Morbidly obese patients are prone for intraoperative hemodynamic disturbances and postoperative airway complications.Aim:Comparison of intraoperative hemodynamics and postoperative recovery characteristics of desflurane versus sevoflurane in morbidly obese patients undergoing laparoscopic bariatric surgery.Settings and Design:Randomized controlled trialMaterials and Methods:After institutional ethics committee approval and written informed consent, 40 morbidly obese patients (BMI > 35 kg/m2) were randomized to receive desflurane or sevoflurane as part of a standardized general anesthesia technique. Volatile anesthetic concentration was titrated to maintain electroencephalographic bispectral index score (BIS) in the range of 40-60. Mean arterial pressure (MAP) and heart rate (HR) were recorded preoperatively, at induction and intubation, then at regular intervals. After extubation, early recovery was recorded by time to emergence and orientation to time and place. In post anesthesia care unit, intermediate recovery was assessed by modified Aldrete Score and Digit Symbol Substitution Test (DSST).Results:Intraoperative MAP and HR did not differ between the two groups (P > 0.05). The time to response to painful stimuli, obeying verbal commands and spontaneous eye opening was shorter (P = 0.001) and modified Aldrete Score was higher after desflurane anesthesia than after sevoflurane anesthesia (P = 0.049). DSST also returned towards normal faster after desflurane (28.50 ± 6.30 min vs. 35.0 ± 5.62 min, P = 0.03).Conclusions:Both desflurane and sevoflurane produce similar hemodynamic changes but the immediate and intermediate recovery was significantly faster after desflurane thus contributing to fast tracking and early discharge of patients.

Postoperative recovery after anesthesia in morbidly obese patients: a systematic review and meta-analysis of randomized controlled trials

“…[13][14][15][16][17][18] We observed a statistically significant difference in time required for eye opening between the two treatment groups (weighted mean difference [WMD]: -3.10 min; 95% CI: -5.13 to -1.08). Patients who received desflurane required a significantly shorter time for eye opening than patients who received sevoflurane.…”

“…2. Three studies used acceptable methods of randomization, 17,18,20 and four studies clearly described the method of allocation concealment. 3,13,20,21 Three studies did not mention the blinding procedure, 15,19,22 and only one reported no blinding of the outcome assessors.…”

“…Seven RCTs compared recovery outcomes of patients given desflurane vs sevoflurane for maintenance of anesthesia, 3,[13][14][15][16][17][18] and six trials evaluated the time required for eye opening. [13][14][15][16][17][18] We observed a statistically significant difference in time required for eye opening between the two treatment groups (weighted mean difference [WMD]: -3.10 min; 95% CI: -5.13 to -1.08).…”

“…In seven trials, desflurane was compared with sevoflurane for maintenance of anesthesia. 3,[13][14][15][16][17][18] Two studies compared the recovery profiles of patients given sevoflurane vs isoflurane for maintenance of anesthesia. 19,20 Another two studies compared the recovery parameters of patients given intravenous anesthesia with those given propofol and inhalational anesthesia.…”

“…3,13,20,21 Three studies did not mention the blinding procedure, 15,19,22 and only one reported no blinding of the outcome assessors. 18 Eight studies incorporated an intention-to-treat analysis, 3,13,15,16,[18][19][20]22 and in all trials, an acceptable number of patients (\ 20%) withdrew during the follow-up periods . Selective reporting was estimated as low risk in all trials.…”